Our Jacked Up Healthcare “Industry”

I have known for a long time that the medical industry in this country is just that: an industry. It’s about making money, not necessarily caring for people and making them better. I have heard stories about people who didn’t have insurance, or didn’t have good insurance, being denied for life saving medical procedures. I watched the movie “John Q” and cried, knowing that those kinds of stories really happened. Still, I never had any personal experience with the money-making side until recently.

When my husband got a new job a couple of months ago, he found out he wouldn’t have insurance through his company for the first six months. I was not thrilled about it, but I knew he had a better job and hoped that once he got benefits, that they would be good ones. I purchased a family policy from Blue Cross Blue Shield and thought I had a made a good decision for our family.

The plan I chose is known as a High Deductible Health Plan, or HDHP. This means that we have an insanely high deductible, $10,000 to be exact, and until we meet that, the only thing that is covered is preventive care. I can take the kids for well-child check-ups, they can get vaccines, my husband and I can get check-ups, but if any of us get sick, we have to pay for that. The benefit of a HDHP is that they are cheaper, and the federal government allows you to open a Health Savings Account, or HSA. A HSA is a special type of savings account that can be used for most medical, dental and vision expenses and the money is tax-deductible.

We have had the policy for one month now and I haven’t had the opportunity to open the HSA yet so we don’t have money sitting in a separate account to use for doctor’s visits. I’ve actually only used our insurance once in the past month when I had a suspicious problem in my breast checked by a specialist. I’m still waiting on the bill from that.

Today, I finally decided after six or seven weeks of my son coughing, that it was time for him to be seen. We tried treating it at home, natural and herbal remedies and even acupuncture. Nothing worked. He had the same problem last winter and the doctor told me then that we would just have to wait it out, that there was nothing to give him. That’s why I waited so long to take him in.

When we arrived at the doctor’s office, I presented my new insurance card, expecting them to send the claim to the insurance company and bill me for whatever was left over. The receptionist explained that their policy was that people had to pay up front, and then if the insurance said that the “allowable amount” was less than what I paid, I would get a credit on my account, not a refund. When you go to an “in-network” doctor, the insurance company tells them that they’ll pay a certain amount of each procedure or visit, and then whatever remains the doctor’s office has to write off. It’s called the contracted rate, or allowable amount. According to the receptionist, cash paying patients would have to pay $85 to see the doctor, but a BCBS patient only had to pay $60.

She refused to bill me. She said it wasn’t their policy to see what the insurance company deemed as “allowable”.

I asked if I could wait and pay until after I had seen the doctor. I really don’t like paying for services before I receive them. I told her that if the doctor listened to my son and said that he couldn’t do anything, only time would fix it, that maybe he wouldn’t charge me the office visit. I’ve had that happen on several occasions.

The receptionist laughed at me.

She said, “Of course he’ll charge you! You have to pay for his time!”

To that I replied, “Really? $60 for a 5 minute visit?”

She said, “Yes, it’s his time, you’re seeing him so you have to pay.”

You know what I should have asked her? I should have asked her if I had unknowingly scheduled an appointment with God Himself?!

I know doctor’s have to take time to chart and they don’t see one patient after another after another, and some visits are slightly longer than others. However, for the average 5 to 10 minute appointment, do you realize that it equates to $360 to $720 per hour?

Seriously.

I was in a real mood with this woman by this time. She was not budging with her policies and I couldn’t believe that the contracted rate for a 5 minute appointment was $60. Since I’d been through all this before, I knew that there was an excellent chance that the doctor would tell me to wait it out. I’d been told that before. Evan’s lungs were clear, he had no other symptoms and his cough was mostly at night and in the morning. He has post-nasal drip that I can’t figure out how to dry up.

By this point, tears welled up in my eyes because I was so angry. When I’m in public, if I get mad, I cry. I was so mad that this woman was treating me like this. She was speaking loudly to another family about how she had to wait on me to decide if I wanted to pay or not to be seen. She wouldn’t let anyone else check in while I tried to call my husband for him to (1) calm me down and (2) tell me what to do.

In the end, I trusted my gut instinct and I took Evan by the hand and told the lady that I wasn’t going to pay their outrageous charges when she couldn’t even guarantee that we would even receive any treatment. We walked out of that office with tears streaming down my face. That receptionist completely humiliated me, but at least I stood up for myself and my child and followed what my heart was telling me to do.

This just further solidifies my point that I hate the medical establishment. Yes, they have their place and I know there are good doctors out there, but they are rare. Everyone else cares about how much money they can bring in, telling patients to be on time while they make them wait for an hour for a five-minute appointment before they are shuttled out the door so the next patient can come into the room. Why else make patient’s pay up front?

We all know that something is clearly wrong with the medical system in this country. I don’t think Obama’s health care reform bill was or is helpful, but something has to change. The focus needs to shift away from money and back to the patient and overall health and well-being. Until then, we’re in a big pot of hot water.


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